The success of the Socialist Health Association (SHA) motion to Labour’s 2017 conference – calling for the party to “restore our fully-funded, comprehensive, universal, publicly-provided and owned NHS without user charges, as per the NHS Bill (2016-17)” - marks significant progress. Indeed, the unanimous passage of the motion is a “historic moment” (see Keep Our NHS Public’s assessment). Despite Corbyn being a registered supporter of the NHS Reinstatement Bill, and Diane Abbott’s 2016 Conference Speech as Shadow Health Secretary, neither the bill nor its principles featured in Labour’s 2017 Manifesto. When the NHS Reinstatement Bill was first presented in Parliament by a Labour MP (Margaret Greenwood, Wirral West) on 13th July 2016, just 9 other Labour MPs joined her to support it.
Docs Not Cops as a group supports the NHS Reinstatement Bill (and argued for its adoption at Labour Party Conference) not only because its central function would be to restore a publicly owned, managed and accountable NHS, but because as currently drafted it seeks to ensure healthcare is available on the basis of need, not ability to pay or migration status. The bill contains a commitment we feel is essential - to “abolish the legal provisions passed in 2014 requiring certain immigrants to pay for NHS services”.
The 2014 Immigration Act is not the limit of the government’s ambitions with regard to scapegoating migrants for the crisis in the NHS, however. The Conservatives followed this up with a 2016 Queen’s Speech promising an NHS (Overseas Visitors Charging) Bill, and an immigration checks pilot scheme in twenty NHS Trusts. Recently released guidance from the Department of Health indicates that new ‘overseas visitor charging’ regulations will come into force on October 23rd, forcing school nurses, health visitors and community mental health teams to charge patients up front if they are not entitled to free NHS treatment.
Though Corbyn raised the issue of the passport checks for NHS services pilot at Prime Ministers’ Questions in November 2016, Labour as yet appears to have no formal policy and little to say in public about the range of “hostile environment” policies the government has been creating for migrants – whether in the NHS or education, housing, or with regard to access to bank accounts and driving licenses. Last year Corbyn challenged Theresa May: "Instead of looking for excuses and scapegoats, shouldn’t the prime minister be ensuring health and social care is properly secure and properly funded?” However, this line of argument has otherwise been rare in recent Labour campaigning.
There is no lack of opportunities to highlight the harmful impacts of government policy – the Trusts running pilots on NHS immigration checks have attracted some media attention. London North West Healthcare sent a letter demanding documents to prove eligibility for NHS from an eight-day-old baby. Barking, Havering and Redbridge University Hospitals NHS Trust (BHR) sent at least one pregnant woman a letter threatening that future appointments may be cancelled if she cannot pay a deposit for treatment. BHR states that patients will be asked to pay a deposit before treatment starts, and will be billed afterwards (£6,500 for maternity care). Those deemed ineligible for free treatment will be charged 150% of the usual NHS rate for their care.
Nor is there a lack of evidence that the policy reflects a desire to scapegoat migrants for a crisis for which they are in no way responsible. At St George’s Hospital in Tooting – the Trust which prompted Corbyn’s comments at PMQs - they’ve just concluded an evaluation of the first part of their pilot into ID requirements for patients in maternity care. The report found ‘no obvious issue with eligibility in obstetrics’, and the new policy led to just 18 out of 1,660 of patients being charged for care (1%) over the course of the pilot. These 18 people are now the targets of the hospital’s debt collection agency - we don’t know anything about them, their jobs, or their families. We don’t know anything about their complicated immigration or asylum statuses – or how they can possibly pay the £45,000 they have been charged in total. We do know that their details may be passed on to the Home Office; a practice that has been going on for years, but has just this year been set out in a Memorandum of Understanding.
On 30th June, Doctors of the World set up a clinic for Grenfell Tower survivors following reports from volunteers at the scene “that many undocumented migrants and asylum seekers who lived in the tower are not coming to official relief centres or institutions, even if they have serious injuries, because they fear being referred to Home Office immigration teams.” Despite these and many other stories, immigration checks and charges were not mentioned specifically in the SHA’s NHS motion. Though the references to “comprehensive” and “universal” care and clear emphasis on an “NHS without user charges” are welcome, further clarity is needed. There has been much discussion of Labour’s immigration policy in the context of Brexit, and debate about whether Corbyn’s rhetoric shows signs of shifts. More importantly, however, evidence from councils run by Labour is not encouraging.
On September 18th, North East London Migrant Action (NELMA) spoke at an event called ‘Immigration policy: what is the scope for a radical approach from Labour’. In their talk they noted that “elected Labour politicians and Labour-run local authorities are, for the most part, our antagonists rather than our allies” when it comes to keeping kids from street homelessness. “With a few exceptions” - they argue - “the only way to compel Labour-run local authorities to uphold the rights of destitute migrant children is to take them to court”. Just this week The Bristol Cable reported that Labour-run Bristol council will liaise with Home Office immigration enforcement officers “to build a stronger intelligence picture of migrant rough sleeping” in order to remove homeless non-UK citizens, including people from the European Economic Area (EEA). While the council cuts £106m from public services - £33m this year alone - between 2017-2020, it has successfully won two years of funding worth £180,474 for council’s Safer Bristol Anti-Social Behaviour Team and the local policy from the government’s £100m Controlling Migration Fund.
The government is trying to blame the severe and growing NHS funding crisis on migrants, but this is a distraction. The numbers don’t add up: ‘deliberate health tourism’ costs, at most, £300 million a year – just 0.3% of the overall NHS budget. The costs that can be recouped by charging people for their care are a drop in the ocean for the NHS, but potentially ruinous for patients now being landed with multi-thousand pound bills – or being put off accessing healthcare altogether. At present, Labour’s response has been minimal, and there is no indication yet that the policies the government has introduced would be abandoned were a Labour government elected. Indeed, some elements within the party and the actions of the councils mentioned above might lead people to conclude the opposite - though there is a strong body of pro-migrant opinion among the party membership, which could have a crucial say on shifting party policy in this area. It is imperative that these policies are overturned, in the interests of migrant solidarity and indeed basic humanity.
NHS workers shouldn’t be forced to police the people they’re treating. It is costly and time-consuming – and not only does this raise difficult medical ethics issues for already overstretched staff; it will destroy the relationship of trust between NHS staff and patients. The way to ensure the NHS funding crisis ends is by ending PFI contracts and the billions wasted on running the NHS as a market – policies the Labour Party is at long last adopting. We ask Labour members and supporters to put pressure on the party at all levels to ensure the neither migrant rights nor the right to healthcare on the basis of need are trampled on. And that they consider joining us at our #PatientsNotPassports event on Saturday 30th September when Docs Not Cops along with a coalition of anti-racism and pro-migrant organisations will gather in London, Manchester and Newcastle to protest the introduction of immigration checks and upfront charging for all NHS patients and to share stories highlighting the human impact of these changes.
Docs Not Cops are a group of NHS staff and patients that work to combat racism in the NHS. We believe no one should be afraid to access the healthcare they need, either because they can’t pay or might be punished, and that NHS workers should not be forced to police the people they treat. We believe healthcare is a basic human right and that no one should be afraid to see a qualified professional. http://www.docsnotcops.co.uk
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